Bone Mass, Microstucture And Strength Can Discriminate Vertebral Fracture In Patients on Long-Term Steroid Treatment
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AbstractCONTEXT:
Measurement of areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) was able to predict fracture risk. High-resolution peripheral quantitative computed tomography (HR-pQCT) yields additional information about volumetric BMD (vBMD), microarchitecture, and strength that may increase understanding of fracture susceptibility.

OBJECTIVE:
To ascertain whether vBMD, microarchitecture and estimated bone strength derived from HR-pQCT can discriminate vertebral fractures in glucocorticoid-induced osteoporosis (GIOP) patients independent of aBMD.

DESIGN:
A cross-sectional case-controlled study.

SETTING:
Seven regional hospitals in Hong Kong.

PATIENTS:
110 patients on long-term glucocorticoids with vertebral fracture determined radiographically, and 110 patients on long-term glucocorticoids without fracture.

INTERVENTION:
None.

MAIN OUTCOME MEASURES:
We assessed 1) vBMD /microarchitecture/ bone strength; and 2) aBMD; and 3) fracture risk assessment tool (FRAX).

RESULTS:
Vertebral fracture patients had lower total vBMD and a thinner cortex at the distal tibia after adjustment for age, gender and aBMD or FRAX. In the anti-resorptive treatment naïve sub-group, vertebral fracture patients also had lower total vBMD at both the distal radius and tibia after adjusting for covariates. Lower total vBMD and a thinner cortex were also noticed in the non-osteoporotic, or FRAX score of <10% sub-groups with vertebral fracture, and were also associated with increasing prevalence of vertebral fracture.

CONCLUSION:
GIOP patients with vertebral fracture have a significant reduction in total vBMD and cortical thinning independent of aBMD and FRAX. These changes may help to identify high risk patients in the subgroups currently considered to have low fracture risk by DXA or FRAX.
All Author(s) ListShen J, Griffith JF, Zhu TY, Tang P, Kun EW, Lee VK, Yip RM, Kwok KY, Ying SK, Ho CT, Lau SL, Pui MO, Li TK, Lau EY, Lee JJ, Qin L, Tam LS.
Journal nameJournal of Clinical Endocrinology and Metabolism
Year2018
ISSN0021-972X
eISSN1945-7197
LanguagesEnglish-United States

Last updated on 2020-19-09 at 03:59